How can abnormal sexuality be defined?
Abnormal sexuality is behavior that is compulsive, destructive, cannot be directed towards a partner, or is associated with guilt/anxiety.
Sexual innervation involves two neural circuits. Can you name the nerves that contribute to them?
The CNS circuit uses somatic (pudendal), PNS (S2-4), and SNS (T11-L2) outflow.
The spinal reflex arc appears to only use somatic (pudendal).
Most of you are probably familiar with the four stages of sexual response. That said, here are some challenge questions:
1. What occurs in men during plateau? In women?
2. In which stage can uterine contractions be seen?
3. Which sex experiences nipple erection upon initial arousal?
4. In which stage is "tenting" seen?
1. Men (Increased size, upward testicular movement, pre-ejaculate), Women (contraction of the outer 1/3 of the vagina, forming the orgasmic platform)
3. Both genders experience nipple erection
4. In initial arousal (women)
What was the primary criticism to Masters' linear model of sexual response?
How was this remedied?
It did not reliably reflect a woman's sexual experience (not all women experience all 4 stages).
It was replaced by a more bizarre but cyclical model in which emotional intimacy and psychosocial affect play a greater role.
Distinguish between primary and secondary sexual dysfunction?
What is required for this diagnosis to be made?
Primary is lifelong, secondary is acquired and more common.
The difficulty must be a source of distress to the individual.
Name 3-4 biological causes of sexual dysfunction.
Medical conditions (eg Diabetes causing erectile dysfunction or pelvic adhesions causing dyspareunia)
Medications (eg SSRIs delaying orgasm)
Substance abuse (eg Alcohol)
Hormonal or neurotransmitter alterations
Name 4 psychological causes of sexual dysfunction
Anxiety (including of performance, guilt)
Sexual disorders may be split into four categories relating to parts of the physiological sexual response.
Describe two disorders of desire, and who they affect.
Sexual hypoactivity is a reduction or absence of sexual drive.
Sexual aversion is an avoidant response to all sexual contact.
These more often affect women.
Describe three descriptors of erectile dysfunction; that is, how a patient might describe his difficulty.
What can be said about the etiology of the dysfunction if it is absent upon masturbation or coincides with normal REM & morning erections?
Difficulty obtaining erection.
Difficulty maintaining erection.
Decrease in erectile rigidity.
If the dysfunction only occurs during sex, psychological factors are probably to blame (guilt, performance anxiety...)
What is female sexual arousal disorder?
How is it different from hypoactive sexual desire?
"Absent/reduced interest" affecting up to 33% of females.
I would interpret this as a difficulty achieving arousal rather than a complete absence of drive (ie hypoactive sexual desire).
Describe the epidemiology of female anorgasmia.
How might a patient describe it?
Overall prevalence of 30%; 5% of married women aged 35 have never achieved orgasm (yet, incidence decreases with age).
Delay in, infrequency of, or absence of orgasm, or reduced intensity.
You can probably guess what delayed and premature ejaculation are by their names.
How might you treat premature ejaculation?
SSRIs, squeeze or stop-and-go techniques.
What is vaginismus?
How is it treated?
How can I make these cards more interesting?
Painful contraction of the vagina (outer-third) during or in anticipation of sex, preventing penile insertion.
Psychotherapy, pelvic floor exercises, dilators
______ is a condition that involves general pain associated with sex. It occurs mainly in _____, either before, during, or after sex.
What symptom is noted often in sexual assault victims?
Dyspareunia, mainly in women.
Chronic pelvic pain.
Describe 4 treatments for erectile dysfunction.
Opioid antagonists, vasodilators (eg PDE5-inhibitors), intracorporeal injections, implanted prosthetics.
Describe the benefits that may be conferred by sensory-focused exercises, desensitization and masturbation.
Sensory-focused exercises to improve disroders of desire, arousal, and orgasm.
Relaxation/desensitization to reduce anxiety (eg in Vaginismus)
Masturbation to improve ease of arousal and orgasm.
Define the follow:
Gender Identity: Sense of self as being male or female (note this is independent of actual genetic sex)
Gender Role: Expression of one's gender identity in society (IE a female might identify as a male, but act in a female gender role to avoid discrimination)
Sexual Orientation: Preference of sex for sexual and romantic partners (true bisexuality is uncommon and most people have some preference)
What is gender identity disorder?
What criteria are needed for a diagnosis?
A condition where one identifies as a gender different than their biological sex
- Strong, persistant identification with opposite gender
- Identification with opposite gender is not based on perceived social, cultural advantages
- Persistant discomfort about one's sex and discomfort with accompanying gender roles
How is gender identity disorder treated?
What is NOT the goal of treatment?
- Treat mood/anxiety disorders related to GID
- Hormonal treatment
- Sexual Reassignment Surgery
- must be co-commitent with hormone therapy
- must live cross-gendered for 3-12 months
The purpose of theapy is NOT to reverse cross-sex identification!!
What constitutes intimate Partner Violence?
- Physical Violence
- Sexual Violence
- use of physical force to compel a person into a sexual act
- attempted sexual act with a person who is incapacitated and unable to give consent
- abusive sexual contact
- Threats of Physical or Sexual Violence
- Psychological/Emotional Violence
What acts can constitute elder maltreatment?
Who is the most likely perpetrator of elder maltreatment?
Can include physical abuse, sexual abuse, psychological/emotional abuse, financial abuse, neglect, or abandoment
A family member
What is sexual violence?
Who is usually the victim and who is usually the perpetrator?
Any sexual activity where consent is not given
The victim is usually female and the perpetrator is typically a known male. However, males can also be victims.
What are postpartum blues?
What is the onset?
How common are they?
Relative emotional disturbance including mood lability, tearfulness, anxiety, insomnia following birth
Peks about 3-5 days after birth and usually resolves within 2 weeks
VERY common. 70-85% of women get it.
What differentiates post-partum depression from postpartum blues?
What are risk factors fo post-partum depression?
Onset and Severity; Blues resolves by 2 weeks post-partum while depression starts after two weeks
- 1 year post-partum
- symptoms before birth
- previous pregnancies
- previous post-partum depression
- stressful life events
- conflicts with baby's father
- low infant birth weight
- infant health problems
- less than 1 year between pregnancies
What risks does post-partum depression pose to the mother?
What risks does post-partum depression pose to the infant?
Difficulty breastfeeding, marital and relationship difficulties
Missed pediatric appointments, decreased IQ, slowed development, impaired attachment, less emotional expressiveness, increased psychiatric disorders